Nifedipine + Acebutolol in Combination Gives More Effective BP Control Than either drug alone in patients with moderate to severe hypertension

A randomised crossover study was designed to compare the antihypertensive efficacy of nifedipine + acebutolol in combination with either drug alone. 12 patients with moderate to severe essential hypertension received, in randomised order, oral nifedipine 20mg bid, acebutolol 200mg bid and a combination of both for 4 weeks each.

Mean supine BP was reduced from 173/111 mm Hg at baseline to 160/103mm Hg 12 hours after the final dose of nifedipine (p < 0.01/p < 0.05), to 161/1 03mm Hg after acebutolol (p < 0.01/p < 0.01) and to 152/100mm Hg after nifedipine + acebutolol (p < 0.001 vs baseline; p < 0.05 vs acebutolol; p = 0.06 vs nifedipine). The exercise-induced rise in standing systolic BP was attenuated by each treatment and nifedipine + atenolol attenuated the exercise-induced rise in standing diastolic BP (p < 0.05 vs pre­exercise). Mean supine heart rate was significantly reduced by acebutolol and nifedipine + acebutolol.

Mild symptomatic adverse effects including headache, malaise, flushing, dizziness, undue sweating, lethargy, urinary frequency, mild ankle oedema, constipation, abdominal pain, dry skin and leg pains were reported. Mean plasma renin activity was significantly increased 2 hours after the final dose of nifedipine and significantly reduced 12 hours after the final doses of acebutolol and acebutolol + nifedipine. Acebutolol significantly increased mean plasma potassium levels, and mean plasma urea levels were significantly higher after nifedipine and acebutolol monotherapies.

Thus, the twice daily administration of nifedipine + acebutolol in combination gives better BP control than either drug alone in the treatment of patients with moderate to severe essential hypertension. Singer ORJ. Markandu NO. Shore AC. MacGregor GA. Journal of Human Hypertension 1 31·37. Jun 1987

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